MEDICARE: BRIDGETT BUCKERY LCSW PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1205499324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGETT BUCKERY LCSW PLLC

Provider Business Mailing Address
First Line	:	19011 119TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3324
Country	:	US
Telephone Number	:	718-415-0871
Fax Number	:

Provider Business Practice Location Address
First Line	:	19011 119TH AVE STE A
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3324
Country	:	US
Telephone Number	:	718-415-0871
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT , CEO
Name	:	MRS. BRIDGETT BUCKERY
Credential	:	LCSWR
Telephone Number	:	718-415-0871

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	08/28/2019

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